Tips & Advice for Newborns (Neonatal IV Insertion)

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Miriam Wahrman

MSN/Ed,RNC-MNN

Master

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Outline

Nursing Points

General

Supplies
1. Gather all the supplies and have them ready
  1. Friend- it helps to have extra hands
  2. 24G IV catheter
  3. Pigtail/extension set
  4. Armboard
  5. Heal warmer
  6. Alcohol/betadine
  7. Clear tape
  8. Tourniquet/rubber band
  9. Tegaderm
  10. Cotton balls
  11. Transducer
  12. IV flush (3ml-too much pressure from a 10ml can blow the vein)
Positioning
1. On a warmer – need to provide warmth
2. Cover eyes with their hat-block the light out for more comfort
Tips & Tricks
1. Put a cut (clean with alcohol) rubber band on the upper arm and see what you can see
  1. DO NOT leave the tourniquet on for too long, occasionally remove and let blood flow enter the extremity
2. Rub hard with alcohol to try and get veins to “pop”
3. You can also use heat from the heal warmer on the location you are assessing
4. A transducer can help show where the veins run if you can not see one
Insertion
1. Alcohol or betadine the location
2. Insert at a 10-degree angle
3. See the flash? gently push the catheter all the way in and remove the needle
4. Attach a FLUSHED extension set and flush the IV (This is where the extra hands help)
  1. Flushes smoothly? Great
  2. Has IV blown? Remove and attempt a different location
5. Secure the line
  1. Apply the Tegaderm and tape to secure
  2. Apply arm board to keep arm straight and tape
  3. If IV is in the hand
    1. Cotton ball under the IV if it sticks out past the hand to secure it from being bumped and pulled

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Transcript

Hey guys, today I’m going to go through setting up a newborn IV and inserting it. Unfortunately, we don’t have a baby here for me to actually insert one on, but I’m going to walk you through all the steps to hopefully make it easier for you whenever you have to do this. So the one important thing with newborns is that you obviously want to make sure your hands are clean as with any patient, but on a newborn you want to be bare from the elbows down. So no rings, watches or anything that could carry germs to this newborn. So I have done that and now I’m just going to put my gloves on so we are ready. So one of the things, usually you’ll have a baby on a radiant warmer, to have the extra bright light on them so you can visualize the veins and what you’re doing.

So you want to just take their hat and we pull it over their eyes just to help block out that light cause it’s so much stimulation. They’re used to a really dark environment and now they’re out in all these bright lights around. So use that to cover just over their eyes. So that we block some of the light out. The next thing is you want to make sure you have all your supplies set up and get your tape ready. So these little babies get a little bit combative and it can be hard to juggle all the things. So you want to have everything set up. So you want to have a few of the large pieces of tape and you can just hang them on the sides of your warm or table or wherever you’re inserting the IV. And then you want to have some, thinner pieces you can tear to do your chevrons. Okay? The next thing you want to make sure everything is prepped. So, you are going to saline, flush your pigtail.

Okay. After you guys have flushed your extension set and that is ready, you will move on to placing the IV. So you’re going to put your tourniquet on. So we use rubber bands at our facility and anywhere I’ve seen, if you do this, you just want to wipe them down really well with alcohol. You will tie it around the baby’s arm and do your release quick release, not so you can quickly release that tourniquet. We don’t want to leave the tourniquets on more than like a minute or so because we don’t want to cut off blood supply to long to that extremity. So you are going to do that and you’re going to rub kind of aggressively with the alcohol wipes so that you can cleanse the skin but also try to get those IVs to pop. Unfortunately, newborns are hard to place an IV on because they’re a little bit dehydrated. Sometimes those veins, they’re very fragile and then they’re flat cause they already hydrated. All right. When you find that vein, you are going to place your IV.

So you have your IV, this is the type that, we have here, but you might have a different one in your facility. So you will get it into the vein. You only want to be at like a 10-degree angle, so not too high because we don’t want to go too deep. And keep it superficial. You will insert that IV and get it in. Hopefully see a flash of blood in there and then you know you are good. So once that end this will go to your sharps container. So you have your IV in place and then you are ready to quickly cause blood is coming out of this attach and you are going to flush with a 10 CC syringe. You want to be really careful not to push too hard cause you don’t want to blow that Bain. So you are going to just gently push through and flush it. Once that is good, you can hopefully have extra hands helping you here. Lock that. Now that you’ve gotten that in, we are going to Chevron and get this thing secured. We use a lot of tape. The next thing. Once that’s there you’ll get your arm board ready because you don’t want to have the IV in their AC. And then there’ll be bending their arm a lot of getting into fetal position. So this way the arm board will help keep that arm straight. So you’ll be getting that ready. You will Tegaderm and you just want to be careful not to cover too much of that lower part.

So we have our Tegaderm in place and then even more tape on this arm board to secure the baby’s arm to it. So sometimes if you have the IV down here, it’s a small surface area space. So we need to make sure that if the baby is going to bump this, it’s not going to dislodge the IV. So sometimes we will tear a cotton ball and place a piece under and add even more tape around that to secure that these kids are covered in tape when we’re done. That’s putting an IV. The last thing you want to do is re-stick them. All right. So if you have this all set, you flushed the line and have it locked, you can disconnect and then you’re ready to give whatever medication you need to get. I hope this helps you guys, so you’ll be ready to start those newborn IVs and be successful. Now go out and be your best self and as always, happy nursing.

Tips & Advice for Newborns (Neonatal IV Insertion)

You're watching a preview. 300,000+ students are watching the full lesson.

Included In This Lesson

NURSING.com students have a 99.25% NCLEX pass rate.

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Nursing Points

General

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